Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children

Arthurs, Owen J.; Thayyil, Sudhin; Pauliah, Shreela S.; Jacques, Thomas S.; Chong, W.K.; Gunny, Roxana; Saunders, Dawn; Addison, S; Lally, Peter J; Cady, Ernest B.; Jones, Rod; Norman, Wendy; Scott, R. K.; Robertson, Nicola J.; Wade, Angie; Chitty, Lyn S.; Sebire, Neil J.

doi:10.1016/j.crad.2015.04.008

Cited by 73 publications

(71 citation statements)

References 20 publications

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“…Our data show similar sensitivity and specificity values for 1.5-T as compared with published data for the brain, thorax and musculoskeletal structures [25][26][27]. However, the sensitivity and specificity of abdominal structures at 1.5-T was lower in our study [28].…”

Section: (Range 125-346) Weeks Including 10 Fetuses Below 20 Weekssupporting

confidence: 43%

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Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy

et al. 2017

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Section: (Range 125-346) Weeks Including 10 Fetuses Below 20 Weekssupporting

confidence: 43%

“…1.5-T MRI has been shown to have sufficient image quality for most major brain abnormalities [25]. In our study using 3-T magnets, diagnostic accuracy for dysmorphologic features of the face was not significantly improved, but the diagnostic error was decreased.…”

Section: (Range 125-346) Weeks Including 10 Fetuses Below 20 Weeksmentioning

confidence: 66%

Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy

et al. 2017

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“…In addition, in this series, in 16% of the cases, formal neuropathological examination at fetal autopsy was not possible due to maceration and autolysis, and in these cases PMMRI supplied diagnostic information in around 50% of cases. However, limitations apply; in particular, PMMRI is poor for detection of cerebral hypoxic ischemic injury [84]. PMMRI is of value in detection of cardiac pathology, with an overall sensitivity of 73% and specificity of 96% for any cardiac pathology, being more accurate for major structural heart disease (sensitivity 93%, specificity 99%) [85].…”

Section: Postmortem Magnetic Resonance Imaging (Pmmri)mentioning

confidence: 99%

Perinatal death investigations: What is current practice?

Nijkamp

Sebire

Bouman

et al. 2017

Seminars in Fetal and Neonatal Medicine

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Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.

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“…Placental examination was performed as part of the fetal autopsy, when available. The brain was extracted only when there was a clinical indication to do so, or if an abnormality was discovered on postmortem MRI, with appropriate parental consent.…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure

Hutchinson

Shelmerdine

Lewis

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. Methods This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5‐year period. Following preprocedure 1.5‐T whole‐body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi‐square analysis was used to compare the ‘unexplained’ rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. Results MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. Conclusions The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high‐ and low/middle‐income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children

Cited by 73 publications

References 20 publications

Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy

Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy

Perinatal death investigations: What is current practice?

Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure

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